Monthly Medicare Supplement Rates for03/11/2015 CHOICES

Standardized Plans in Connecticut 1-800-994-9422
NOTE: The rates shown may vary by mode of payment. Check with the company for more information.

Company Individual Plans / Telephone Number / Pre-ex Cond. / Disabled
(1) / A(1) / B(1) / C(1) / D / F / F(2)
High
Deductible / G / K / L / M / N / Date (3)
Approved
American Progressive Life & Health Ins. Co / 1-800-645-4116 / 6 mos. / A,B,C, / $343.19 / $444.26 / $535.14 / $486.02 / $508.18 / $84.93 / $446.11 / $186.25 / 3/06/2015
Anthem Blue Cross & Blue Shield / 1-800-238-1143 / 6 mos. / A / $330.90 / $241.96 / $160.24 / 10/23/2014
Colonial Penn Life Insurance Company / 1-800-800-2254 / N/A / A,B / $700.31 / $697.78 / $513.55 / $60.68 / $407.80 / $129.57 / $279.16 / $413.82 / $283.67 / 09/22/2014
Combined Insurance Company of America / 1-855-278-9329 / 6 mos. / A / $168.63 / $214.57 / $202.42 / 176.94 / 12/11/2013
Equitable Life & Casualty Insurance / 1-800-352-5170 / 6 mos. / A / $192.33 / $304.33 / $195.08 / 01/26/2015
Globe Life & Accident Insurance Co / 1-800-801-6831 / 2 mos. / A / $172.50 / $271.00 / $50.00 / $180.00 / 02/13/2015
Gov’t Personnel Mutual Life Insurance / 1-866-800-5566 / N/A / A, C / $325.59 / $438.20 / $336.65 / $262.91 / $233.35 / 8/01/2014
Humana Insurance Company(5) / 1-888-310-8482 / 3 mos / A / $269.43 / $291.46 / $88.48 / $278.40 / $121.04 / $187.22 / $226.59 / 12/01/2014
Loyal American Life Insurance Company / 1-866-459-4272 / 6 mos. / A / $227.11 / $252.35 / $219.54 / $184.21 / 12/31/2014
Omaha Insurance Company / 1-800-235-8340 / N/A / A / $397.96 / $284.26 / $240.45 / 05/19/2014
Transamerica Life Insurance Company / 1-800-331-2512 / N/A / A,B,C / $140.24 / $185.16 / $219.07 / $202.52 / $220.34 / $202.42 / $100.90 / $149.78 / $184.43 / $173.42 / 12/11/2014
United American Insurance Company / 1-800-331-2512 / 2 mos. / A,B,C / $189.00 / $287.00 / $333.00 / $329.00 / $327.00 / $58.00 / $322.00 / $135.00 / $189.00 / $196.00 / 12/23/2014
USAA Life Insurance Company / 1-800-531-8000 / N/A / A / $349.18 / $243.27 / $164.90 / 12/10/2014
Group Plans (4)
United HealthCare Insurance /AARP / 1-800-523-5800 / 3 mos. / A,B,C / $134.25 / $183.75 / $280.25 / $220.25 / $70.75 / $114.00 / $145.00 / 09/24/2014

(1)Plans for Disabled - All companies must offer Plans A. If a company also offers Plan(s) B and/or C, then it must also offer the plan(s) to disabled Medicare beneficiaries.

(2)High Deductible Plan - This plan provides the same benefits as Plan F after one has paid a calendar year deductible of $2,140 for 2014 and $2,180 fro 2015.Out of pocket expenses for this deductible are expenses that would ordinarily be paid by the plan. These expenses include the Medicare A and Bexpenses that would ordinarily be paid by the plan. These expenses include the Medicare A and B deductibles, but not the foreign travel emergency deductibles.

(3)The date a company's rate was approved is not necessarily the date the rate change will take effect. Check with the company for the effective date.

(4)These are group plans that are available to individuals enrolled in Medicare. Payment of a group membership fee is required.

(5)Company also offers Plans A, F, High Ded. F, K and N with dental and vision benefits for additional monthly cost of $13.25

Benefit Chart of Medicare Supplement Plans

A / B / C / D / F / F* / G / K / L / M / N
Basic **, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance / Hospitalization and preventive care paid at 100%; other basicbenefits paid at 50% / Hospitalization and preventive care paid at 100%; other basicbenefits paid at 75% / Basic**, including 100% Part B coinsurance / Basic**, including 100% Part B coinsurance,except up to $20 copayment for office visit, and up to $50 copayment for emergency room
Skilled Nursing FacilityCoinsurance / Skilled Nursing FacilityCoinsurance / Skilled Nursing FacilityCoinsurance / Skilled Nursing FacilityCoinsurance / 50% Skilled Nursing Facility Coinsurance / 75% Skilled Nursing Facility Coinsurance / Skilled Nursing FacilityCoinsurance / Skilled Nursing FacilityCoinsurance
Part A Deductible / Part A Deductible / Part A Deductible / Part A Deductible / Part A Deductible / 50% Part A Deductible / 75% Part A Deductible / 50% Part A Deductible / Part A Deductible
Part B Deductible / Part B Deductible
Part B Excess (100%) / Part B Excess (100%)
Foreign Travel Emergency / Foreign Travel Emergency / Foreign Travel Emergency / Foreign Travel Emergency / Foreign Travel Emergency / Foreign Travel Emergency
Out-of-pocket limit $4800; paid at 100% after limit reached / Out-of-pocket limit $2400; paid at100% after limit reached

** Basic Benefits:

Hospitalization: Part A coinsurance plus coverage for 365 additional days after Medicare benefits end

Medical Expenses:Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plans K, L, and N

requireinsured to pay a portion of Part B coinsurance or copayments.

Blood: First three (3) pints of blood each year

Hospice: Part A coinsurance

*Plan F also has an option called a high deductible plan F. This high deductible plan pays the same benefits as Plan F after one has paid a calendar year ($2140) deductible. Benefits from high deductible plan F will not begin until out-of-pocket expenses exceed $2140. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B, but do not include the plan's separate foreign travel emergency deductible.

Revised 03/11/15